As per mkj2486, "A mechanical complication would be if the G tube itself has a problem. In this case the patient is the problem". But even patient pull the G tube or the G tube is fell out (or as per the given info.) the G tube have complications & so replaced. Hence I coded as above.

Just to replace the G tube is not a complication! If the reason for the encounter is just to remove and/or replace the G tube the correct code is the V55.1. A coder cannot diagnose a complication when the provider has not indicated that one exists.

Hi, Debra. Thanks for weighing in on this. I value your opinion, and agree with you on the V55.1 Dx.

My question is the CPT, and I'm thinking by the description that it would be considered part of the E/M visit.

This was not even the specific reason for the visit, it was part of a regular home visit, and the provider just had one fraction of a sentence in the note "reinserted PEG". I'm having a hard time justifying coding the 43760 with a $400 reimbursement for what sounds like the provider just popped a tube into a port. Also, the description says "change" gastronomy tube, not reinsert the one that the patient pulled out.

Question: A patient presented with a clogged gastrostomy tube. After examining the existing tube site, the physician deflated the balloon. The existing gastrostomy tube was removed. A new balloon tube was tested and inserted without the use of fluoroscopic guidance. What is the appropriate code to report for this procedure?

Answer: The appropriate code to report for this procedure is code 43760, Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance.

My question is a clogged tube a complication of the original placement? We have a scenario where the patient had one placed in an open fashion, comes to the office with a clogged catheter and the provider replaces it. If this is a complication, I cannot use modifier 78 for the office replacement (place of service 11), so does a replacement then become routine post operative care and not separately billable or is modifier 79 applicable?

Does a clogged gastrostomy tube fall into the services included in the global surgery payment as per Medicare?
All additional medical or surgical services
required of the surgeon during the post-operative
period of the surgery because of complications,
which do not require additional trips to the
operating room;
Or is it
Clearly distinct surgical procedures that occur
during the post-operative period which are not reoperations
or treatment for complications;

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